Delirium Tremens and the Alcoholic

March 29, 2017
Johann Kassim

Delirium Tremens (DT) is a state of hallucinating, sweating unusual amounts (diaphoresis), fast heartbeat (tachycardia), hyperthermia, hypertension and agitation as a result of abstaining from alcohol over a period of time.

It happens between three to ten days from the last drink, with symptoms worsening around the fourth day of abstinence. Nights are usually when symptoms tend to be at their worst.

Symptoms of DT

Patients suffering from DT will exhibit the following symptoms.

Rapid onset of confusion

See or hear things that others can’t see or hear (Delirium)

Shaking

Shivering

Irregular Heart Rate (Tachycardia)

Sweating (Diaphoresis)

Very High Body Temperature (Hyperthermia)

Seizures

Causes for DT

Brain is deprived of food and oxygen

Alcohol or sedative drug withdrawal

Drug abuse

Electrolyte or other body chemistry disturbances

Infections such as urinary tract infections/pneumonia – This is more likely with people who have a pre-existing brain damage either from stroke/dementia.

Poisons

Surgery

What’s the diagnosis? DT OR Alcoholic Hallucinosis?

DT and Alcoholic Hallucinosis are separate issues. The latter occurs not long after withdrawal sets in, while the former usually begins 48 to 96 hours after the last drink. One must take care not to take the wrong diagnosis as and when delirium sets in with regards to alcohol/drug withdrawals. This is because the symptoms may be similar, but the pathophysiology and treatment is somewhat different.

Who is at risk of  DT?

  • Someone who has a history of sustained drinking
  • A history of previous DT
  • Older than 30 years old; though if the patient is younger, please refer the patient to a doctor for proper diagnosis
  • The presence of a concurrent illness
  • The presence of significant alcohol withdrawal in the presence of an elevated alcohol intake
  • Longer period of abstinence  (Longer than two days = DT)

Death Rates

There is a 5% chance of dying from DT. It has decreased from 37% as recorded in the early 20th century. This is due to improved pharmacology and therapies as a result of swift action when the patient exhibits sign of illness. However, death usually occurs due to arrhythmia, pneumonia, pancreatitis and hepatitis. Old age, pre-existing heart conditions, high body temperature and coexisting liver disease can also increase the likelihood of death from DT.

Treatment Process & Guidelines

Tests to rule out alternative diagnoses

A premature diagnosis of alcohol withdrawal can lead to inappropriate use of sedatives and hence further delay accurate diagnosis. There’s a need to rule out illnesses that mimic DT such as meningitis, trauma (intracranial hemorrhage), metabolic derangements, drug overdose, hepatic failure and gastrointestinal bleeding. In line with this, it may be necessary to do extensive testing such as lumbar puncture and cranial CT to derive confidence around proper DT diagnoses.

Symptom Control and Supportive Care

Once comorbid illnesses have been sufficiently excluded from the diagnosis or treated; the process continues with alleviating symptoms; and; identifying and correcting metabolic derangements. Benzodiazepines are administered to control psychomotor agitation and prevent escalation of severe withdrawal symptoms.

Additionally, nutritional support is given in the form of intravenous fluids, vitamins and minerals. This is because DT sufferers are highly malnourished and they have a high autonomic metabolism, which demands a greater deal of nourishment. However, in early recovery, they are given “nothing by mouth” (NPO) due to aspiration. Patients are encouraged to be in restraints to protect themselves and those around them. However, once sedation sets in, restraints are to be removed for it may cause more harm.

Symptom-triggered therapy

Medication needs to be provided as symptoms arise. Therefore, regular systematic assessments need to be done to monitor the patient’s status.

Patients with moderate to severe alcohol withdrawal will be put in the Intensive Care Unit (ICU). For older patients, who are likely to suffer from DT and may not tolerate the systemic stress of major withdrawal; standard monitoring will include continual assessment of vital signs, pulse oximetry, fluid status and neurological function.

The Solace Difference

At Solace Sabah, we have received many patients who have had alcohol addiction. We have a specialized and scientifically researched method in our clinical conduct of our clients’ withdrawal. Rest assured if you or your loved one may be experiencing the onset of DT, make sure you notify us right away. We have the medical support necessary to bring you or your loved one from the imminent fatal dangers of DT to the transformative and nurturing life of recovery.

The process of withdrawal is not something you or your loved one can face alone. It is something that needs proper management and care. Here at Solace Sabah, we care for you or your loved one who is suffering from this affliction and we will ensure a peaceful, stress-free and harmonious transition from a pain-ridden life to a purposeful existence.

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